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Boy, born 2010
Microtia, absence of iris (Aniridic keratopathy?)
Ty is a handsome little guy who will be 5 years old in September. He was found abandoned when he was about 4 months old. His initial exam at the orphanage discovered he has microtia affecting his right ear. Ty is able to hear. In fact, the orphanage staff reports his hearing is very good! Ty also has an absence of iris in both eyes. They have diagnosed him with cataracts, however, with the iris issue, he may have aniridic keratopathy. Ty's file was done when he was 2 years old, and we are waiting for more recent info. At 2, he was climbing into and out of his crib, and loved to play with toys. Ty was imitating, and saying a few words. His receptive speech was very good. Ty (at 2) did not like to be alone. That is the one time he would be very sad, Ty needs a family…one with several kids would be great! That way, he would always have someone around to play with. No more loneliness! Ty is waiting for you!
Ewan was born in January 2012. Little is known about him at this time. He is able to walk and may be nonverbal, but in videos from 2015, he appears to respond to questions asked of him by shaking his head no.
We are hoping to receive more information on Ewan soon.
Felix was born in February 2011 and has been diagnosed with arthrogryposis. He is an active, friendly boy who interacts well with other children, loves his caretakers, and knows everyone by name.
Due to his medical condition, Felix cannot yet walk, but he is very mobile by crawling. He can sit and stand independently and is fully potty-trained, but needs assistance with feeding. Felix speaks in sentences and while a little shy with unfamiliar people to start, he quickly warms up and shows his happy personality.
Arwen was born at 32 weeks gestation in March 2013 and has been diagnosed with hydrocephalus for which a shunt was placed in July 2013 as well as cysts on his brain. He takes medication for epilepsy, but has not had a seizure since November 2014. Arwen also has esotropia and a cardiologist monitors his heart after he had sinus bradycardia.
Even though Arwen's development is delayed, he is an interactive boy who tracks with his eyes, babbles, follows simple instructions, and giggles. Arwen has head control, can sit without support for a little while, and uses his hands. Arwen can chew small bites of solids and guide finger foods to his mouth.
From a family who met him in August 2015: This little guy charmed me every time I saw him – such a smiley guy and so responsive to interaction from others. He enjoyed attending mass and parties, too. So joyful.
Married couples only.
Remy was born prematurely in August 2014 and has been diagnosed with post-hemorrhagic hydrocephalus for which a shunt was placed in infancy and hypertensive hydrocephalus syndrome. It is unclear how much Remy can see due to bilateral congenital diffuse cataracts.
Remy has head control and tracks with his eyes in all directions. He looks and smiles at familiar adults. At this time, he does not reach for toys. His caretakers say that Remy is doing quite well and that he laughs a lot.
From a family who met him in August 2015: Remy's first birthday was celebrated in conjunction with our daughter's farewell party. Remy's super cute and fell asleep during the festivities of lots of people and music!
Married couples only.
Age: 2
Diagnosis: caudal regression syndrome
He sits alone and stable. Often stands on four limbs an crawls on hands Puts rings and pieces with a small hole on the stand. He has a good attention span when interested in a particular toy or object. The child understands and responds to praise and prohibition. Performs simple orders, but generally not prone to group games or activities. He is happy when banter by an adult and likes to cuddle. He can distinguish between familiar and unfamiliar people. He can pronounce syllables and short words, but rarely, only when he decides.
In the videos, he is independently maneuvering his wheelchair and also navigating his environment by using his hands to "crawl".
Photos, videos and a detailed medical report are available through the agency.
Because we only have this child's file for a short time, he will not be able to receive donations until a family is found for him.
Boy, born 2011
Severe delay of physical and mental development
NOT available until Fall 2016
He is currently not available until fall 2016 but his coding may change once he has a new medical exam when he is transferred soon! We will update as soon as we know!
From a family that met him 6/15:
We spent about a week with this sweet boy when we were adopting our son in June 2015. He is so desperate for love. He called me momma and begged my daughter and me to hold him. We loved on him as much as possible and he soaked it up. He picked up English words very quickly, and remembered day after day that I had hand sanitizer in my purse and asked for it by saying, "soap!" He loved to play ball with my kids, and the nannies would let him push the baby carriage around during walks. He has the most infectious giggle I've ever heard. He walks well, but the nanny indicated that he has issues with his knees. It didn't stop him, though!
He needs a good, patient, and loving family to give him what he needs. He is so skinny and needs good nutrition. He has very minor orphanage behaviors, but from the progress he made just being with us for a few days, I know he will flourish in a caring family. He will be transferred to a horrible place (the director of the orphanage told me it is horrible), likely very soon, since he's almost 4.
This region is beautiful and very cost efficient. The orphanage director is lovely. The facilitators are amazing, and the judge is hilarious and wonderful! You will be able to stay in a hotel and walk to the orphanage and enjoy the beauty and culture of a wonderful town.
LOTS of videos available!
Boy, almost 4 years old
Infantile cerebral palsy; gastroesophageal reflux disease; delayed physical and neuropsychological development.
The child's weight and height are correspondent to his age. He stands up by using a fixed support and even makes steps when held by hands by an adult or by using a walker! He takes and holds small toys in his hand and reaches towards a desired object. The child plays with toys for a while and tries to imitate the adults' actions. The child has difficulties concentrating but he is able to concentrate for short periods of time. He keeps his attention focused for long enough on certain activities that he likes. The boy memorizes actions and manipulations and he performs them often in his everyday life. The boy laughs aloud when jested by an adult. He reacts emotionally to familiar adults and situations from his everyday life. He pronounces prolonged sound combinations. The child enjoys listening to children's songs.
Because we only have this child's file for a short time, he will not be able to receive donations until a family is found for him.
Boy, born 2011
Spina bifida, hydrocephalus
Kyle is 3.5 years old with an adorable smile! Kyle was abandoned when he was only one month old. He had surgery for a meningocele and had a shunt placed for hydrocephalus when he was only 7 months old, but is now doing well although he does not yet have bowel or bladder control. Kyle is described as an active little boy who is walking and talking and has age-appropriate mental development. He likes to play with toy cars and to dance along to music! Could Kyle be your son?
Boy, born 2014
hydrocephalus (post-op)
Charlier is a cute one year old baby boy who was born with hydrocephalus. He was abandoned at the gate of the orphanage at three months old. He received surgery in July 2015. His fine motor skills appear to be on track. Charlier is now able to crawl, but not able to sit up, stand or walk yet. He eats well and babbles. He loves to listen to music and his favorite toy is a drum-shaped rattle. Can Charlier be the son you are looking for?
Boy, born 2010
Cerebral palsy
Maximilian is an adorable little guy who recently turned 3 years old. He came into care as a newborn, and was diagnosed with CP. Max has good fine motor skills, excellent speech (although they say he has a short tongue tie), and is able to walk…but not for long distances. Max's head tilts to the right; this could be a result of the CP. Maximilian is a delightful little boy, whose cognitive skills are on target. His receptive speech is great, and he follows instructions well. He can easily express his needs. The nannies describe him as "strong and brave". They also said when he sees the other kids walking and doing things he would like to do he wants to be like them. Max works very hard when exercising…he wants to be strong and able to run and play with his friends. Max need a family, good therapy, and treatment to straighten his neck. Max needs you!
Boy, born 2010
spina bifida
Lou is almost 5 years old. He was abandoned near a botanical garden when he was 2 days old. Lou was born with a lumbosacral meningomyelocele, and had surgery when he was only 17 days old. He had some weakness in his legs and delayed walking, but he's doing well now. He does not yet have bowel or bladder control. Lou is described as a lovely and outgoing boy who loves to smile. He can count, do simple addition and subtraction, and sings simple songs. He wears orthopedic shoes but he can run and jump and likes to play ball outside with the other children. Lou's speech development is age appropriate. Can Lou be your son?
Boy, born 2012
limb differences
Hugo is a sweet little boy who turned three years old this summer. Hugo has deformities in his left forearm and hand, but he has adapted well. He can use his left hand to hold a pen, cellphone and building blocks but has difficulty picking up small objects. Hugo also has an issue with his right wrist but his caretakers report that his right hand function is more flexible and a little different but basically normal. Hugo is reported to have good coordination. Hugo is a shy but curious little boy with an infectious smile who loves to play! He knows to wait his turn for the swing, loves to play catch, and to "read" a book. Could Hugo be your son?
Boy, born 2011
spina bifida, hydrocephalus (post-op)
Daniel just turned four years old. Daniel was born with spina bifida and hydrocephalus and he was abandoned when he was only two days old. He had corrective surgeries for both conditions in August and September 2014 and is now doing well (aside from a strange haircut).
We visited Daniel at his orphanage at the end of June, and he was just adorable. He has a scar on his back from his meningocele surgery and scars on the back of his head from his hydrocephalus surgery, but they're not too bad. The best news is that he runs and walks well and he has both bowel and bladder control. Daniel was fascinated by the games on our iPad. Could Daniel be your son?
Boy, born 2010
Sensitive special need
Hank is a "sunny and active" 5 year old boy with a ready smile. He loves playing with other children, singing and listening to music, and watching cartoons. He knows the names of everyday items, can count, communicate with adults, sing nursery songs, and likes to help others. He has a genital malformation that has not been surgically corrected. His chromosome test shows he's a boy.
We visited with Hank at his orphanage at the end of June and he was adorable! He recited a poem for us in Chinese and also knew some English words (banana, apple, watermelon, etc.). The orphanage considers him to be very smart. We have several new videos which will melt your heart.
Can you help Hank have a loving future as part of your family?
Boy, born 2010
Congenital heart defect
Frankie Lee, a sweet little boy, is five years old. He was abandoned at eight months. Frankie was born with a congenital heart disease (complex single atrium, single ventricle) and when we visited with him in late June, his lips and fingernails were a bit blue, so we knew his cardiac needs were pressing. We were able to have him transferred to China Little Flower, and a few weeks ago Frankie had surgery (pulmonary vein diversion and a central shunt). He has made a great recovery and he has returned to his foster family back in his province. He may need additional surgery down the road but his condition is much improved now.
Frankie Lee is reported to have normal intelligence but hasn't attended school yet due to his cardiac condition..
Frankie Lee is a bit shy and very attached to his foster mom. He loves listening to music and dancing along to the rhythm. Could Frankie Lee be your son? Can you provide the cardiac care he needs?
Boy, born 2011
cleft lip (repaired); cleft palate, ptosis
Rick is a 4 year old boy who loves learning. He is well-liked by his foster family and his teachers. He loves playing games with teachers and students, but as an introvert, he sometimes like playing alone. He had successful surgery to correct his cleft lip but will still need surgery to close his palate. Rick is also diagnosed with ptosis (droopy eyelids), but it doesn't affect his vision. Rick has good bladder control during the day, but still uses diapers at night.
Boy, born 2010
meningocele (post-op), hydrocephalus (shunt placed)
Ryan, age 4.5, is an adorable little boy with a bright smile. He was abandoned outside a hospital when he was about 12 months old. Shortly after coming into orphanage care, he had surgery on his back for a meningocele and also had a shunt placed to decrease the pressure in his head caused by hydrocephalus. The procedures were successful and he has recovered well. Now Ryan has good bowel and bladder control.
We visited Ryan in his orphanage in late June and were taken in by his shy smile. He enjoyed playing with our iPad. Ryan demonstrated his excellent walking and running, and sang us a song. The video will melt your heart. Could Ryan be the son you've been searching for?
Boy, born 2010
meningocele and tethered spinal cord (post-surgery), Achilles tendon surgery corrected
Yanni is 5 years old. He was born with a meningocele and tethered spinal cord and was abandoned when he was just two days old. Two weeks later, he had surgery to correct his meningocele and spinal cord and is doing well. Yanni also had surgery on his Achilles tendon. He now walks and runs, and even marched like a soldier when we visited his orphanage in late June. Yanni is potty trained but sometimes needs reminders when he's tired. He counts to ten, knows his colors, and plays well with his foster mom's grandson. Can he be your son?
Boy, 2 years old
low birth weight, congenital hydrocephaly, condition after surgery correction – ventriculoperitoneal shunt, visual impairment – ROV V degree and delay in neuro-psychic development and physical skills.
He catches toys only in touch with right hands, he still does not open his left hand and through tactile stimulus. Missing catching reflex.
Laughing with voice when teased. Often observation of oral stimulation through sucking his hands. He does not imitate sound production but shows emotional respond in caressing speech and touch. During the time when he is not sleeping he is calm.
Because we only have this child's file for a short time, he will not be able to receive donations until a family is found for him.
Boy, born 10/2012
Two year old Dionte is a doll! Dionte is an active and positive little guy. He can walk independently and he can go up stairs with the support of the wall. He is able to hold and use a pencil and he can put blocks into a cup and take them out of the cup. He is able to take off his own clothes independently. Dionte understands the meaning of the word 'no' and will give you things when you ask for them. He can use a spoon to eat and can say 'aunt, brother, sister' and other simple words and sentences in a clear voice. Dionte enjoys playing with other children, playing at parks, listening to music, and playing with blocks.
Boy, born 2012
Williams Syndrome
Little Camron has Williams Syndrome. He loves to dance! When the music comes on, he jumps up out of his seat to move to the music. A love of music (and sometimes an unusual skill with music, often referred to as "savant") is common in children with this genetic condition.
All of the children he lives with in his house love him. They really cherish the time they get to spend with him. He is starting to take his first steps, and with help from his friends, he is learning quickly. Camron is described as an affectionate child. He is very happy with people he knows, and he obeys directions well.
This 4 y.o. boy's special needs are: polymalformative syndrome, epilepsy, infantile cerebral palsy and microcephaly.
Rhett is fed through a nasogastric tube and is fully dependent on adults' care. He easily transits from waking state into light stupor and deep sleep. Lately he seems to be smiling more often when an adult is present in the room, but can not react fully to social stimulation.
Because we only have this child's file for a short time, he will not be able to receive donations until a family is found for him.
Siblings, born October 2010 & January 2012
This 4 y.o. girl resides in a foster family with her younger brother since February 2013. hair. She is happy and sparkling. Partially acquires taught material according to her age. She quickly enters in communication with other people. She has begun to speak, talks actively and a lot, but mostly intelligibly. She is already asking to go to potty but some nights still needs a diaper. Overall, the girl is hyperactive and chaotic. She attends specialized boarding elementary preschool institution.
Her medical diagnosis – mixed specific developmental disorders. Expressive language development disorders. Receptive language development disorders. Physical development delay. Short stature. Disorders of autism specter.
This 3 boy's development is happening a lot faster than that of his older sister, he speaks, understands what he says, and tries to repeat words he hears. This boy attends mainstream preschool educational institution, has partially acquired taught program corresponding his age. He walks independently but his gait is quite slouchy. He can run, but only a little bit – he gets tired fast, begins to sweat and can fall down. He is quite slow, quickly gets offended. He is shy with unknown people. he is very attached to his older sister but she treats his badly (hitting, biting)
His medical diagnosis – psychomotor development delay. Language development delay.
Harvey, the older brother, is 11 y.o. He is active, helpful, kindhearted, he likes participating in different events and enjoys dancing. The boy wants to be a leader among peers. His medical diagnosis – bronchial asthma (in remission).
Hudson, the younger brother, has blue eyes and light blond hair. This 4 y.o. boy plays with toys according to his age. He attends kindergarten, his speech gradually develops. His physical development is good, but he still has slight problems with apprehension, he still has mild delay in mental development. His medical diagnosis – erosive gastropathy (in remission).
Boy, born April 2010
Motor, physical, and mental development disorder
This 5 y.o. boy resides in a foster family since August 2013.
He has not attended kindergarten before, it is planned that soon he will start to attend specialized kindergarten. According to the decision of a pedagogically-medical commission, the boy needs to study in program for children with mixed development disorders. This boy has problems in communication with both – children and adults. He likes to succumb to other children. He has speech disorder, motor movement disorder, but whilst in the foster family, improvement can be seen.
Since he lives in the foster family, he has become brave and he wants to have undivided attention. At times he is very loud, he does everything slowly. The boy cannot be left unattended, he needs a strict discipline. His self-care does not correspond the age.
Boy, born 2011
His medical diagnosis – preterm birth II grade. Foot deformity. Fingers, toes congenital anomalies. Osteogenesis imperfect (type I). Bilateral hydrocele, antenatal damage to the central nervous system.
This 3 y.o. boy has a gentle care, with a passive posture on the back. Hand, foot-stretching movements. He can fix and direct eye-sight, smile. He is smart, talks about many things. In his young age he talks in short sentences. Right now he is bed-ridden and gets outside in a wheelchair and his possibility to walk independently is unsure. Currently he is using special medicine that in long-term can possibly improve the state of his bones, but as of now he gets a fracture approximately once in three months.
Boy, born August 2013
Motor delays
Rigby is a precious little one who is 22 months old. He came into care when he was about 10 months old…wheezing, and in need of help. After some TLC from the nannies, there was improvement in his health and motor skills. He was still behind his peers, but had become a very engaging and social baby. At 17 months of age, Rigby could roll over, sit with some support, and play with toys. Rigby was not able to crawl or walk at that time. He loves to be around the other kids. The more action, the better! The nannies have noticed he has high muscular tension and uncoordinated movements. There was no formal diagnosis made in his file which had resulted from a thorough exam. Rigby is an active, loving, happy little guy who really needs a family and some good therapy to help him with his gross motor skills. He needs to come home.
Boy, born September 2010
Hydrocephalus, Dandy-Walker Syndrome, post-operative meningoencephalocele, post-operative peritoneal shunt of arachnoid cysts
Handsome 4.5 year old Hewitt is a sweet little boy who needs a family willing to look past all the labels he's been given and see him for the precious little boy he is and the wonderful son he will be. Hewitt can sort objects by color, follow directions, make great eye contact and conversation, and draw quite well. He is clearly a happy little guy with a sweet and gentle personality. Hewitt is from a very good orphanage and he is living with a foster family on the grounds of the orphanage. Hewitt loves to play and sing!
Hewitt is diagnosed as having hydrocephalus and Dandy Walker syndrome and is postoperative for a meningoencephalocele and postoperative for a peritoneal shunt due to arachnoid cysts.
Boy, born Sept 2010
Not only is Maddock super handsome, but his caretakers describe him as smart and lovely. He was abandoned at about 3 years of age and now lives in a foster family. Maddock is deaf. Although he cannot hear or speak, he can express his needs. If he wants to eat something, he will tap/pull his foster mom to get him what he's asking for. Maddock manages all of his own self care needs and likes to keep his toys and clothing tidy. If his clothes are dirty, he will ask to change. If his socks are dirty, he will take them off and wash them himself. He can also help the younger kids put on and take off their clothes. Maddock likes playing toy blocks with the younger kids and he enjoys writing. He can use a spoon or chopsticks to eat and his favorite foods are meat and eggs. Maddock attends the school for the deaf in his city with the other deaf children from his orphanage. He can understand simple Chinese sign language. Maddock is so handsome, capable, and ready for a forever family! Could you be the lucky family to get to walk this cutie into school and see his sweet little wave every day?
Boy, age: 2
Cerebral Palsy
He reaches out, picks up and holds toys, transfers them from one hand to another and knocks two blocks one against the other. His attention is stable if he is interested in something. When someone reaches out to him, he changes his body posture in order to be picked up. He differentiates between familiar persons and strangers and when contacted reacts with a smile. He demonstrates preference to some of them. He is calm among his peers in the room and follows them with a look when they move or produce sounds. He manipulates with and explores objects independently. He likes to look at books with pictures.
Photos and videos from June 2015 are available through the agency.
Because we only have this child's file for a short time, he will not be able to receive donations until a family is found for him.
Boy, 3 years old
multicystic encephalopathy, infantile cerebral palsy and delayed physical and psychomotor development
Jebb responds to familiar voices; produces guttural sounds; holds a toy that has been handed to him; smiles slightly when someone is speaking to him in a gentle voice. The child falls asleep easily and his sleep is calm. He is fed with a feeding tube. He is calm while his clothes are changed as well as during hydrotherapy procedures.
He raises his head for a short period of time, while in a supine position, with his head turned to the left.
The agency also has video available.
Because we only have this child's file for a short time, he will not be able to receive donations until a family is found for him.
Boy, born October 2011
Lower limb weakness
Three-year-old Acer is quite the cutie! Acer is diagnosed as having lower limb weakness. He came into care at the approximate age of two, so he has only been in the orphanage for a little over a year and a half. His nannies report that he has big beautiful eyes and is very handsome….that is clear from his pictures! When his file was prepared in Oct. 2014, he could stand up and walk while holding onto something or holding someone's hand. He could also walk by pushing something like a small stool. He is cooperative and can help put on and take off his own clothes and shoes. Acer's favorite toy is the wooden rocking horse! He can get on and off of it and likes sitting and riding on it. Acer likes to hold the milk bottles to help feed the younger children. He also likes playing outside. The slide and swings are his favorite, but he enjoys playing with balls and toy blocks too. He can build a tower with 5-6 blocks. He doesn't want the other kids to touch his blocks or he'll cry. Acer likes taking baths and playing in the water. He eats noodles, eggs, and bread regularly. Acer receives some physical therapy, but would benefit so much more from the love and support of his own family.
Boy, born May 2010
Right hemiplegia, pigmented nevus on back of shoulder
Gorgeous 5 year old Bairn lives with a foster family that has 4 other children and he gets along with them very well. Bairn's gross motor skills have improved- he can run and climb as well as his peers. If he is in a hurry when he runs, he sometimes falls. His fine motor skills are also improving. He mainly uses his left hand, so the foster family encourages him to use his right as a helper hand as much as possible. Occupational therapy would really be very beneficial for him. Bairn enjoys singing and dancing in his preschool class! Maybe Bairn will sing and dance his way into your heart and eventually into your home.
Boy, born June 2011
Cleft palate, post-op cleft lip, limb differences for hands and feet
Meet Jeremy! Jeremy just celebrated his 4th birthday. He is an outgoing and energetic little boy who loves playing games. Jeremy will help his therapy teachers clean up and organize the toys in the rehabilitation room. Though he is missing fingers and toes on all four limbs, he does many things for himself, such as eating meals and putting on his shoes. His language is somewhat delayed, likely because his cleft palate has not been repaired yet. He understands simple directions and can point to his ears, nose, mouth and hands when asked. He walks well on his own and can go up and down stairs. He especially enjoys music and likes to kick a ball around when he plays outside. Jeremy has the best smile- he just radiates happiness! We hope adorable Jeremy will be home to celebrate his 5th birthday with a forever family of his own!
Age: 2
Diagnosis: Shunt placed to repair hydrocephalus; heterozy
Dylan was hospitalized at 3 months old with viral meningitis. At that time, neurological testing was conducted and hydrocephalus was diagnosed. A VP shunt was installed and Dylan's neurological care continues to be followed by doctors at one of the top hospitals in his birth country. After routine lab work, Dylan was diagnosed with anemia. When his body did not respond to the common treatments, he was referred to a hematologist, who diagnosed him with heterozygous β-thalassemia. Blood work is done routinely in the orphanage to monitor this condition.
Developmentally, Dylan is sitting up, playing with toys, making sounds and interacting with adults. He eats mashed foods and drinks from an open cup. He will stand when held by both hands.
Photos and videos from August 2014 are available from the agency.
Because we only have this child's file for a short time, he will not be able to receive donations until a family is found for him.


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Deviant Art
Change of hearts 1Fanfic of SherlockChange of hearts 13 years ago in Introductions & Chapters More Like This
Change of hearts 1
Sherlock's POV
"I can't believe my dear Howard is gone!"cried the old widow out as peramedics removed the dead body of her murdered husband. "Anyone who pops to mind that hated your husband so much that he wanted him dead?"I asked not interested in the grief of the wheeping widow.
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Shame at the Check-OutShame at the Check-Out3 years ago in Short Stories More Like This
FIMFiction link: http://www.fimfiction.net/story/56451/Shame-at-the-Check-Out
Shame at the Checkout
Beads of cold sweat rolled down Rainbow Dash's neck. The hot ceiling lights above intensifying the anxiety she felt to such a point that she felt as though she was going to pass out. There she was, standing in the middle of Ponyville's largest store. Her eyes were wide, staring at the newest piece of fan-merchandise being sold.
No, it wasn't anything to do with the Wonderbolts.
It was a limited-time offer Daring Do wallet. Rainbow Dash had to keep her mouth shut to prevent drooling. The wallet was grey and had adventurer's face printed on the front, grinning competitively at some invisible foe. She was a force to be reckoned with, even as just a picture. Hilariously, based on how she looked out of the wallet, Rainbow Dash felt like she was the foe- her hero's ruby eyes piercing into her own like arrows in bows, primed to fire.
Overall, it was beyond awesome, much better t
A General History of EraERA "Though the desert is constantly changing, it always endures."A General History of Era3 years ago in General Fiction More Like This
OVERVIEW Era consists of one half of the Flame Alliance, Era is geographically the largest of the six countries, nearly the size of Arcena itself. The majority of its land is occupied by the Great Northern Desert, which spans roughly 80% of Era's land. It is surrounded on all sides by sea, save the south, where it shares a land border with Pramize. Although the most expansive of the six countries, Era also boasts the least number of people per square mile, and is an unforgiving terrain. Era's nominal capital is Lux Aeterna, and is subdivided into five provinces corresponding roughly to the major nomadic groups of Era.
ETYMOLOGY Era is named for the warrior queen of the same name. The provinces of Era are named for the overarching nomadic groups that occupied them - Durga, Saras, Shri, Vinay, and Murun. Each province's capital city was built and named after the Arcenan Conquest, and,
Kingdom Hearts 10-Year Anniversary PartyKingdom Hearts 10-Year Anniversary Party4 years ago in Humor More Like This
Warning: Mentions of Yoai near the end. Thank you~!
Sora: Yay! It's been ten awesome years! Riku can you believe it's been ten years?
Riku: *laughs* Yeah, ten whole years of existence.
Demyx: And many more to come~!
Saki: *comes out of the kitchen with a cake* Hey guys, check out what I made!
In Saki's hands is a white frosted cake with a hallow blue heart (like the logo), in its center were the Heartless, Nobody, Unversed, and Dream Eater symbols. All over the rest of the white cake surface were crowns, Keyblade, Shadows, Dusks, Floods, and Bat-Bats drawn in frosting.
Xigbar: Wow Lil' Siren, that looks awesome!
Ven: What kind of cake is it?
Saki: *smile* Chocolate with cream cheese frosting.
Leon: Cream cheese? Does that even work?
Saki: *pout* I wanted to try it. *goes and sets it in the center of a table with a bunch
The Elemental Hearts: MizushinThe Elemental Hearts: Mizushin3 years ago in Profiles More Like This
The Elemental Heart Seris:
Quick Details
Name Traslation: Water Heart
Age Position: Middle Sister, Younger than Koudoshin, elder than Aisushin
Spirit Form: A spirit form of a water dragon. (Link in the description)
Sealed Form: A regular Katana with a Sapphire Blue hilt. (link in the description)
Released State: Link in despription
Release Command Words: "Let loose the rushing tides, Mizushin!"
True Release: Link in the Description
True Release Command Words: "Mizushin, unleash the tsunami! Bankai!"
True Release Name:
Omoi Nami Mizushin (Emotion Wave Waterheart)
Partner Gem: None
Release Abilities: The manipulation and control of water, and water based reiatsu. This allows the wielder to use techniques such as the Mizu Kousen, which focuses and pressureizes water in the left palm to three charges and fires off in power levels based on the charge level. She will also grant her wielder the power and ability to form a shield and sword out of pure water, these techniques are known
BBC Sherlock: Wanting moreJohn had sometimes really strange dreams and the one he was experiencing right now was definitely among the weirdest. He felt a big and slimy snail sucking on his forehead, trying to make a hole in his skull and slurp up his brain. John tried to scream or defend himself, but he was powerless.BBC Sherlock: Wanting more3 years ago in Romance More Like This
He was relieved when he woke up and the surreal dream ended. However, the sucking feeling didn't go away, which almost gave him a heart attack. He jumped up in the armchair, causing Sherlock to back away.
"What the hell?" He asked in utter confusion, fixing his gaze on Sherlock's intrigued face. He moved his hand to his forehead and felt a moisture there. "What the hell, Sherlock?" He repeated with anger.
"Waking somebody up with a kiss is said to be very romantic." Sherlock stated in a scholarly tone.
John looked at him with disbelief and snorted.
"Where did you get that?"
"You need to stop reading that crap," he sighed and shook his head with resignation. Sherlock's new hobby
Cry for Eternity - Chapter 2Cry for Eternity - Chapter 23 years ago in Drama More Like This
Searing flames.
Five seconds? Five minutes? Five millennia?
It didn't matter. There was no past, no future. Only the flames.
Oh, there was the light too! A light that came from everywhere! But mostly there was the flames.
Twisting, flickering, burning at her very soul. The pain was immeasurable, but it had always existed, as far back as she could remember, and she could remember a long time.
Or maybe she could... It was somewhat hard to measure time when there was nothing for her to measure it against. There was only the flames, eating away at her, yet never making her any smaller. Forever burning, the fire was all that existed.
Her body was... Wait, did she even have a body? Maybe she did at some point. At least she thought she did. Maybe she did. She hoped it was a nice body, one with a soft mane and maybe some nice friends to go along with it. Oh! And a name! She remembered that she had had a name at one point. It was a pretty name too. She had liked her name! She wished she
The Elemental Hearts: KoudoshinThe Elemental Hearts: Koudoshin3 years ago in Profiles More Like This
The Elemental Hearts Seris:
Quick Details:
Name Translation: Earth Heart
Age Position: Eldest of the sisters, 2nd oldest over all, younger than only Raikoushin and Ankokushin
Spirit Form: A dragon who has given up her wings to walk the earth. (A possible link in the description.... Still need to find a dragon I like.)
Sealed Form: Link in Description
Released Form: Link in Description
Release Command Words: "Shake the world, Koudoshin!"
True Release: Link in Description
True Release Command Words: "Shake the world to it's very core! Ban-KAI!"
Gem Combination: The Emerald of Blister
Released Abilities: The manipulation and control of earth or earth based reiatsu. She allows her wielder do this in a few ways they are: Yurasu Renda, Koudonami, Emeraduo Kousen
Translation: Rock Barrage, Earth Wave, Emerald Beam
True Release Abilities: Koudoshin uses the manipulation and control of the Earth to such an extent in her True Release that she can create physical objects out of the grou
BBC Sherlock: Take my love, take my land...John walked slowly through the cemetery, thinking how lifeless the world looked today. The sky was ashen, painted in a dull, homogeneous shade of grey. There were no sounds, no birds chirping, no beeping of horns, nothing. Only John's steady footsteps on a gravel path were resonating in the absolute silence of the necropolis. The air seemed stale and heavy like in a room that hadn't been opened for years. No trace of wind among the graphite leaves, no gentle blows to ease the pain and chase away all the undesirable thoughts. John wished it was raining. Or storming. It's always easier when the sky at least pretends to weep with you. Instead, the whole place seemed to be wrapped in a shroud, waiting apathetically for its funeral.BBC Sherlock: Take my love, take my land...3 years ago in Romance More Like This
John finally stopped and tried to shake off his melancholic observations, knowing how irrational they were. Sherlock would probably have a field day if he only knew. If.
"It's been three years already, " said John thoughtfully, staring at the tombstone adorned
BBC Sherlock AU: BohemienParis is indeed splendid. Doctor John Watson thought to himself as he was strolling on a boulevard right next to the Seine. Weather was certainly more pleasant here than in England all sunny, with occasional white cloud puffs blowing across the blue sky.BBC Sherlock AU: Bohemien3 years ago in Romance More Like This
John was really glad that he had accepted an invitation to a medical conference, which took place in the capital of France two days ago, and decided to stay in the city for a whole week. A well-deserved vacation, he repeated inwardly with satisfaction. And the hotel was just marvellous.
He glanced mildly intrigued at bookstalls lined up on both sides of the path, but he brought himself to heel and averted his gaze. He wasn't here to browse through musty novels, his purpose was far more important. Or so he hoped, filled with doubt.
It was still relatively early, so the gas lanterns weren't lit. John, however, wished that the darkness could come and engulf him, hiding from prying eyes of other people. As a doctor and a gent
Migidoll FAQMigidoll FAQ5 years ago in Reviews & Guides More Like This
Migidoll FAQ
[last update: July, 2014]
This FAQ tries to give you a general overview for Migidoll dolls so there is just one basic question about Bjd's. If you want to learn more about Bjd's in general please visit Den of Angels for more information.
Contents Overview
1. What are BJDs?
2. Where can I buy a Migidoll?
3. Why is it always saying ''sold out'' for the item I want to purchase?
4. Which heads does Migidoll sell?
5. Can I purchase a head with the original Migidoll face-up shown on the website?
6. Where can I get a body for my Migidoll head?
7. What are the measurements of the Migidoll SD body?
8. How do I order a Migidoll?
9. How much are the shipping costs?
10. How about the payment?
11. How can I contact Migi?
12. What is a A or B type?/ To which body does my A or B type MD head fit? (relevant for heads bought before February 2010
Derpy Hooves Hero of Epsilon 2Derpy Hooves Hero of Epsilon 23 years ago in Humor More Like This
There really is only one thing you should idolize. Me the Muffin Queen. Gather around as I tell you the tale of how I Derpy Hooves the TWC Muffin Queen became the Hero of Epsilon 2.
Spoiler: click to toggle
I have been a great renowned hero especially in the days of yore. For in 1823, I Derpy Hooves came to the planet of Epsilon 2, where the citizens were in an epic war against the evil muffin race. The battles between both sides were of epic proportions. Thousands would appear on the field of battle, and millions (sometimes billions) would die on that same battlefield. After 100's of years the war had come to an end. It was absolutely horrific. Trillions died, humans and muffins alike. But it was the muffins who won the great epic Human-Muffin War, and thus they enslaved the beaten humans. The dastardly cruel muffins would force the humans to produce muffin offspring. Under Muffin Law, the humans were banned from eating fruits, vegetables, breads and pastries. The humans were tortured
You Fucked Me UpYou Fucked Me Up4 years ago in Free Verse More Like This
I gave you my life
And now I'm rotting inside
I gave you my dreams
And now they're fading away
I gave you my hope
And now it's crushed
I gave you my mind
And now it's filled with depression
But most of all
I gave you my heart
but you let it rot
You let it fade away
You crushed it
And you filled it with depression
To say it simple
So everyone will understand
You fucked me up
And I'm recovering, slowly
Lay Off Hasbro and Stop Sending Hate-MailIt should come as no great surprise that during the couple of years that the brony community has been growing, more and more people have been finding reasons to object to some of the decisions that Hasbro have chosen to make. One of the most well-known issues was the infamous 'Derpy' situation, where certain people actively sent hate-mail to Hasbro for 'altering' the Derpy Hooves character. Despite the entire fiasco being unsympathetic and diabolical the community overreaction was embarrassing, to say the least it did a lot to suggest that, when they feel scorned, some bronies can be vicious little bastards.Lay Off Hasbro and Stop Sending Hate-Mail3 years ago in Articles & Interviews More Like This
Being made aware of the radical potential of bronies suggests that history may repeat itself should other changes be made that upset the brony status quo. People seem to forget that Hasbro have their own vested interest in making particular business decisions. Most are agreed upon by bronies, but a few are received poorly by the fandom. But Hasbro's choices are made w
BBC Sherlock: 3 ficlets inspired by songs1.Glee Cast - Smooth CriminalBBC Sherlock: 3 ficlets inspired by songs3 years ago in General Fiction More Like This
The moment Sherlock went inside the house, he knew something was amiss. He had this gut feeling telling him that John was in danger, that's why he ran home like a madman in the first place. But he didn't realise how accurate he was in his predictions, until he saw bloodstains on the carpet. His heart skipped a beat, but he didn't waste any time.
"John!" he yelled at the top of his lungs and rushed headlong upstairs. He was cautious, his senses working at full steam, and he kept tracking the blood trail like a trained dog. His mind started analysing situation and he instantly knew what had happened. John answered the door since Mrs Hudson was away, the visitor stabbed him, John fought him off and started running away into the apartment.
The bloodstains and reddish shoe prints led into Sherlock's bedroom. The door was ajar.
"John, are you okay? ", he shouted while running towards the room. And there John was, lying motionless on the floor in a pool of
BBC Sherlock: Learn to be LonelyJohn wasn't woken up by the suspicious crack of the floorboards, a sudden and inexplicable draught, nor by bright light attacking his pupils. No, the sensation was far more subtle. A certain feeling of absence. The gnawing coldness. The emptiness around him. John slowly opened his eyelids and noticed what was wrong. The other side of the bed was vacant. John's eyes wandered across the room and stopped at the slim silhouette bathed in the moonlight, which only highlighted the paleness of the naked skin. Sherlock was standing by the window and looking out at the quiet and empty street below. He was looking, but not really seeing. His eyes were awash with deep sadness, something John had never observed before.BBC Sherlock: Learn to be Lonely3 years ago in Romance More Like This
"What's wrong, Sherlock?" John asked with worry.
Sherlock flinched a little, not being aware that John had been watching him. His facial expression changed instantly as if he put a joyful mask on.
"Nothing, John. I'm sorry if I woke you up." Sherlock apologised, twisting his lips in
Sherlock BBC: UncertaintyA semi-sequel to Like a VirginSherlock BBC: Uncertainty3 years ago in Romance More Like This
Six o'clock in the morning is never the right time to wake up after a drinking session. John Watson moaned and groaned and tried to go back to sleep, but repeated thuds, rustles and beeps coming from the living room rendered his intention impossible.
He opened his eyelids slowly, but the sunlight attacked his pupils with the force of a nuclear blast causing him to put a pillow over his head with a faint hope to block out the dazzling brightness, which pierced right through his skull. He felt as if a herd of elephants was tap dancing inside his brain, his throat was bone dry and the taste inside his mouth indicated that he must have at least munched on a dead cat. He moaned heartbreakingly once again, wishing he was dead. The noises from the living room, without a doubt produced by Sherlock, certainly didn't improve his psychical and mental condition.
When he finally gathered strength to sit up, he started massaging his temples and tried to pull him
Cry for Eternity - Chapter 7Cry for Eternity - Chapter 73 years ago in Drama More Like This
Five days since the coronation of Princess Twilight Sparkle.
"It was nice to see you, Zecora! Come visit again soon!" Twilight said to her friend as the zebra led her out the door.
"I must say, Twilight Sparkle, our meeting was quite fine! I assure you, the pleasure was entirely mine!" the zebra called back over her shoulder in her signature rhyme.
That went well, for once, Twilight mused to herself. Zecora had shown up several minutes early, bearing a letter confirming her appointment as Ambassador, as well as a large stack of paperwork containing everything from new trade proposals to military treaties. With each new proposal, Twilight felt her confidence grow; each one had been well-written, respectful, and most importantly, beneficial to both nations.
She stepped into the hallway outside the meeting room and stretched out with a pleasurable groan, contemplating taking a brisk walk before her next audience.
"I take it you had a nice
BBC Sherlock: NightmaresThe moment John woke up, he knew something was wrong. He was a light sleeper, courtesy of Afghanistan, so any sign of danger could instantly jolt him wide awake. And now he clearly sensed that his life was hanging by a thread. However, John decided to be cautious and not to make any unnecessary movements, which might provoke an assault. Instead he just opened his eyes slightly and carefully scanned the room shrouded in darkness. Yes, his instinct didn't fail him. There was someone standing at the door. The stranger was motionless, but John could hear him breathing irregularly, as if he just stopped running and tried to calm down. A shadowy, anonymous silhouette, like a monster from children's nightmares.BBC Sherlock: Nightmares3 years ago in General Fiction More Like This
John felt fear rising in his chest, but years of being a soldier helped him to maintain his cool. His mind started racing, desperately trying to figure out what to do. He thought about the gun he kept in a bedside table's drawer, but he doubt he'd be quick enough to grab it before th
To Save Your LifeTo Save Your Life3 years ago in Free Verse More Like This
To Save Your Life
Heroes are hard to come by
Especially in this day and age
Because of you- I am still alive
Hail, the vanquisher of pain
I fought as long as I could have
But I sank into the weakness below
And I felt my sorrow's wrath
The helplessness took over
My fists let go
Of the resistance
I fell from hope
The light faded in the distance
It was all a dream
A wish...
A simple false belief
I hid...
Hands dangled frantically / Tears dripped endlessly
I needed a hero to save me / I yearned to be set free
A hand reached out
Held tight...
I was finally found
Relieved sigh...
I rose back to grace
And the darkness brightened
The savior I awaited
Lifted me up and triumphed
I prayed as much as I needed
Even when I was beyond drowning
I knew a kind soul would pay heed
Every mourning human deserves saving
Sherlock BBC - Like a VirginAs John was staggering up the stairs to their shared flat on 221B Baker Street and struggling to keep his balance in a really pathetic and futile impression of a walk, he thought that spending the whole evening in "Red Lion", drinking pint after pint, maybe wasn't such a good idea.Sherlock BBC - Like a Virgin3 years ago in Romance More Like This
It was all Sherlock's fault, as usual. A few hours ago he announced fervently that he was bored out of his mind, and, since there wasn't any interesting case available, it could be fruitful to go to a pub and try spying on people. After all, drunk clientele are more prone to spill the beans and reveal some juicy secrets. At least that's what Sherlock claimed using more sophisticated vocabulary and making those puppy eyes, which you couldn't simply refuse. The truth was, John didn't really want to oppose this time, because an evening in a pub sounded fantastic. He envisioned that a bit of unwinding will be a nicer pastime than chasing criminals all around London as they normally do. So John was quite glad whe
|Sta.sh Submit

subset: commoncrawl


text:
Top Definition
a rich suburb of philly where half the population is really spoiled liberal jews, while the other half is conservative white christian money hoarders. well, no, thats not true, because there are a few blacks, but they all live in north hills where the houses are like shoeboxes. the asians, all of who are korean, are just as rich as the whites but they dont associate with anyone else except for other asians. besides the blacks, everyone lives in big mansions with ten bathrooms and three car garages where all the spoiled kids who are out of touch with reality get high/drunk every day after school and the weekends. this is why the nickname is Upper Druglin/Drugland, but really it's mostly just drinking. the parents never notice this behavior b/c they are always out of town on business or playing tennis/golf. everyone belongs to country clubs, and drives mercedes, bmws, audis, lexuses, and porsches, even the kids. the school is one of the best in the state because the teachers all make $100,000 a year. the girls are all prissy and blonde and wear abercrombie and fitch, and the guys dont really care about anything but getting head. its necessary for all the girls to have louis vuitton purses, which their parents buy for them, and its not a lie that some parents pay for their kids to get plastic surgery if they ask. every spring break everyone goes to some caribbean island, or florida, because everyones grandparents live there. and in the summer, the kids go on school trips to france, italy, australia, etc, b/c everyone has so much money. basically, its suburban hell.
I saw some prissy jap at the mall. she got out of a mercedes and had a louis vuitton purse. she must be from upper dublin.
by richjap July 25, 2006
rich ass jew community outside philly, pa where japs and pot heads live and herb and sex are plenty!
Damn, Darnell copped some head up in Upper Dublin last week!
by pyan August 03, 2003
Alicia McGlade did not write that chunks did so if you have any probles someone was black mailing her so if you have any problems then take it up with chunks
Alicia McGlade did not write that about Upper Dublin
by Chunks March 18, 2005
A place where the computer class is triping where the fat teachers eat and cant walk up stairs. A place where drugs are delt a lot. And the Basketball program is trippin.
The Basketball team drank and they started to lose games
by Alicia McGlade March 11, 2005
upper dublin commonly referred to upper drugland due to the high drug use, consists of 40%jews, 40%koreans, 19% black kids, 1% christian white kids, athletics not that good, name any drug that still exsists today...iight got the name? yeah well u can find that drug in about 10 minutes upon entering UD, anything from weed to crack, perks to zannies, anythign at all...thats pretty much upper dublin is all about drugs well theres not much to say about UD other then drugs so yeah thats about it
UPPER DRUGLAND highest concentration of drugs in eastern PA
by I would say my name but then i would get shot February 05, 2005
A place where all the girls are either fucken losers or hot as shit but lack personality and are all the same....in every way possible, from cloths to personality. The guys are mostly jewish and are either real quiet and loud and some even think they are African American decent. Drugs are in Upper Dublin but not alot of coke or heron or that gay shit. Basically Chronic is the drug everyone perfers. Who can blame them. There are some asians but in school I hear it's like they got of a fucken boat right there. The black kids are loud and rude, no more is needed to be said on that subject. So basically if you like weed, stupid ass bitches, Jews who some think they are African American decent, UD is the place for you!
Wiggers who smoke weed and get with stupid bitches......
by Fuck no, I will not be giving my name March 31, 2005
Places where Asians and Jews can make love with each other while sleeping in there rich money silk beds.
Asian: Lets make luv u fuckin jew
jew: ok but lets bomb asia first
Asian: ok
jew: wait its already been done
Asian: hahah wait im Asian
jew: fuck it lets make luv
jew: ok but lets bomb asia first
Asian: ok
jew: wait its already been done
Asian: hahah wait im Asian
by R@nd(+)m January 21, 2005


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Hotel Clauzel
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Re-aquianting with Paris
... in the station and a heated 'sausage roll' which was a 12 inch fat baguette style roll, hollowed out, filled with a good frankfurter and topped with melting hot mustard cheese sauce like on a croque monsier. Nom nom too, especially as the outside of the roll was crispy. I don't know which is worse - finding good food everywhere or not?
Our train trip flew by quickly and before we knew it we were in Paris - it felt familiar and good. Once there ...
A Somewhat Notable Date
... definitely get more comfortable as you head west.
Jenni arrives here on Monday morning, so I have a full day tomorrow to try to get my life sorted. Unfortunately I have to face the fact that in just over two weeks I'm heading back to the real world. This means finding a job. I have my first interview next week. It's time to get my head back into business mode briefly.
This is going to be even more difficult than it sounds.
Surviving 3 days in Paris knowing no French.
... waited at their restaurant until I could check in. St. Christopher's Inn was situated in zone 1 of Paris and right next to a canal. The facilities were neat, clean, and fun; I felt safe the entire time. My old fear of hostels is now completely gone! Once I settled in, I headed right back to the metro to make my way to the Eiffel Tower.
The metro I took to get there went above ground while approaching the stop and the view of the Eiffel Tower was astounding. I can't believe ...
Welcome to the neighborhood
... other words required. We had some shopping to do in preparation for the arrival of Ardeth's brother and sister in law (flowers,candles and of course food and wine) so we enhanced our relationship with the local vendors. John G - you would love that we are working our way through the wide selection of patés at the charcouterie place! The cheese shop also continues to be a source of fascinating cheeses - this time surrendering a chabichou and morbier which later was accompanied by ...
Summer on Two Continents
... and me to navigate driving on the other side of the road. Shockingly without an accident, we arrived in Dingle. This quaint harborside town has been called the most beautiful place on earth by National Geographic. We spent an entire day driving around the Dingle Peninsula stopping for views of the Atlantic Ocean. Check out the pictures- it would be impossible to describe the beauty. We loved seeing the quintessential thatched roof houses, Irish farms, and charming cliffside ...


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Best Western Plus Newport News Inn & Suites, Newport News
- Free continental breakfast, free WiFi, and free parking
- Airport within 5 mi/8 km: Newport News, VA (PHF-Newport News - Williamsburg Intl.)
Main amenities
- 65 guestrooms
- Outdoor pool
- Fitness center
- Business center
- 24-hour front desk
- Air conditioning
- Front desk safe
- Self-serve laundry
- Gift shops/newsstands
- Luggage storage
What's around
- Patrick Henry Mall (0.6 mi / 0.9 km)
- Hampton Roads Iceplex (2.6 mi / 4.2 km)
- Virginia Living Museum (3.5 mi / 5.6 km)
- Mariner's Museum (4.7 mi / 7.5 km)
- Virginia War Museum (7.5 mi / 12.1 km)
The beds in the first nights' room were too soft for our liking. The following morning we…
hot breakfast, but needs improvement
Enter dates to check prices
Hotel Info: 1800-687-236 (Australia Toll Free)from A$101
- Suite, 2 Double Beds, Smoking, Refrigerator & Microwave
- Suite, 2 Queen Beds, Non Smoking, Refrigerator & Microwave
- Suite, 1 King Bed, Smoking, Refrigerator & Microwave
- Suite, 2 Double Beds, Non Smoking, Refrigerator & Microwave
- Suite, 2 Double Beds, Accessible, Bathtub
- Suite, 1 King Bed, Accessible, Bathtub
- Suite, 1 King Bed, Accessible, Non Smoking
- Suite, 1 King Bed, Non Smoking, Refrigerator & Microwave
- Deluxe Room, 1 King Bed with Sofabed, Smoking
- Deluxe Double Room, Smoking
- Deluxe Room, 1 King Bed with Sofabed
- Deluxe Double Room
Recommended hotels
At a glance
Key facts
Hotel size
- This hotel has 65 rooms
- This hotel is arranged over 3 floors
- Check-in time starts at 2 PM
- Check-out time is 11 AM
- Express check-out
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
Travelling with others
- Children (16 years old and younger) stay free when occupying the parent or guardian's room, using existing bedding
- Pets not allowed
- Free WiFi and wired Internet access in public areas
- Free WiFi and wired Internet access in rooms
- Free self parking
- Accessible parking
Nearby Two Star Newport News hotels
In the hotel
- Free continental breakfast
- Outdoor seasonal pool
- Outdoor pool
- Fitness facilities
- Spa tub
- Business center
- 24-hour front desk
- Laundry facilities
- Luggage storage
- Number of buildings/towers - 1
- Elevator/lift
- Safe-deposit box at front desk
- Disabled parking
- Accessible path of travel
- Accessible bathroom
- In-room accessibility
- Roll-in shower
In the room
- Climate control
- Air conditioning
- Coffee/tea maker
- Iron/ironing board
- Sofa bed
- Sofa bed size double
- Hair dryer
- Cable TV channels
- Desk
- Free newspaper
- Free WiFi
- Free local calls
- Refrigerator
- Microwave
- In-room safe
- Connecting/adjoining rooms available
Top Newport News hotels
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"staff were friendly. Internet was excellent and choice of TV channels great. I was very comfortable there and really enjoyed my stay. Good location . Value for money."Aug 7, 2015
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"Very friendly staff. Courteous and willing to help out whenever possible."Jun 23, 2015
- Comfort Suites BypassFrom
"Room was nice and the staff helpful, but the buffet breakfast was basic and it was a surprise to have to use plastic cutlery and styrofoam plates and bowls!"Apr 22, 2015
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Best Western Plus Newport News Inn & Suites, Newport News's small print
Also known as
- Best Western Newport News
- Best Western Plus Newport News
- Best Western Plus Newport News Inn
- Newport News Best Western
- Newport News Inn
- Best Western Plus Newport News Hotel Newport News
- Best Western Plus Newport News Inn And Suites
The property has connecting/adjoining rooms, which are subject to availability and can be requested by contacting the property using the number on the booking confirmation.
Mandatory fees
You'll be asked to pay the following charges at check in or check out:
- Tourism fee: USD 1.00 per accommodation, per night
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.


text:
I Love this story... I always think about this story, when I am upset with my mom.
I found this story on a facebook page "Muhammad SAW Greatest leader-Make Fastest Growing Page In Fb Share As Much" http://www.facebook.com/#!/muhammadthegrt Everyday I get to read something new and interesting.
I came across this story a couple of weeks ago and ever since then I have been sharing it with my family and friends. At the end of the story I had a tears in my eyes and everyone who I read it did as well. I love my MOM and I am Thankfull to ALLAH have a Mother like her!!
************PLEASE READ*************My mom only had one eye. I hated her She was such an embarrassment. She cooked for students and teachers to support the family.
A Mother's Story ♥ ♥ ♥
There was this one day during elementary school where my mom came to say hello to me. I was so embarrassed.
How could she do this to me? I ignored her, threw her a hateful look and ran out. The next day at school one of my classmates said, EEEE, your mom only has one eye!
I wanted to bury myself. I also wanted my mom to just disappear. I confronted her that day and said, If youre only gonna make me a laughing stock, why dont you just die?
My mom did not respond I didnt even stop to think for a second about what I had said, because I was full of anger. I was oblivious to her feelings.
I wanted out of that house, and have nothing to do with her. So I studied real hard, got a chance to go abroad to study.
Then, I got married. I bought a house of my own. I had kids of my own. I was happy with my life, my kids and the comforts. Then one day, my Mother came to visit me. She hadnt seen me in years and she didnt even meet her grandchildren.
When she stood by the door, my children laughed at her, and I yelled at her for coming over uninvited. I screamed at her, How dare you come to my house and scare my children! GET OUT OF HERE! NOW!!!
And to this, my mother quietly answered, Oh, Im so sorry. I may have gotten the wrong address, and she disappeared out of sight.
One day, a letter regarding a school reunion came to my house. So I lied to my wife that I was going on a business trip. After the reunion, I went to the old shack just out of curiosity.
My neighbors said that she died. I did not shed a single tear. They handed me a letter that she had wanted me to have.
My dearest son,
I think of you all the time. Im sorry that I came to your house and scared your children.
I was so glad when I heard you were coming for the reunion. But I may not be able to even get out of bed to see you. Im sorry that I was a constant embarrassment to you when you were growing up.
You see ..when you were very little, you got into an accident, and lost your eye. As a mother, I couldnt stand watching you having to grow up with one eye. So I gave you mine.
I was so proud of my son who was seeing a whole new world for me, in my place, with that eye.
With all my love to you,
Your mother.
If you find this story useful, please share with a friend!
I Love this story... I always think about this story, when I am upset with my mom.
Last edited by asiya45; 04-16-2012 at 09:05 PM.
Aww bless her.
You made me cry That poor son didn't even get a chance to compensate for what he did to his mother
Are you trying to make cry everyone?Don't try this again.It is painful.
We have to care for those whom we love and don't want to loss them. Care now unless it will so late and you can only cry.
All mothers-related stories make me cry.
It made me cry. not the end but where she said, "I think i may have gotten the wrong address." How much she'd gotten hurt by her sons treatment of her.
I think in Western countries children are raised so they disrespect their parents more and ar embarrased of them. i think even they are embarrased of parents who have no deformities.
i have written an article about this:
Religious Obligation Toward Parents
In the modern age parents are regarded as trouble, especially by teens and young adults who want to have their own way, do their own thing. However this is not only unfair to the parents who sacrificed their lives for the well-being of children, but is also unislamic.
Many verses of the Holy Quran as well as hadith sayings assert the respectful treatment of parents. Allah says in the Quran:
Your Lord has decreed that you worship none but Him, and that you be kind to parents. Whether one or both of them attain old age in your life, say not to them a word of contempt, nor repel them, but address them in terms of honor.
And out of kindness, lower to them the wing of humility and say, My Lord, bestow on them your Mercy just as they cherished me in childhood. (Al-Quran, Chapter 17Al-Israa, verses 2425).
In fact, kind and respectful behavior toward parents comes second to the worship of God as in many verses of the Quran kind treatment of parents, especially in old age, is mentioned right after the rights of God, as in the above verse.
This is only fair because the parents took care of children when the children were weak and unable to survive on their own. Now when parents have become aged and dependent on their children, its their right that the children care for them, not uttering even the word uff to them.
Although sometimes hard to resist, children should try their best not to argue with or talk back to aged parents. Anything that might hurt the parents feelings or make them feel weak or vulnerable should be absolutely avoided. Children should do their best to accompany their parents in old age and to make their end life as comfortable as possible. Afterall, we dont know how long they will be with us before they depart and we never see them again.
Kindness to ones parents is a religious obligation. Even if parents tell you to do something unislamic, you should still be kind to them, while not accepting their unislamic instructions. Allah says in the Quran:
We have enjoined on mankind kindness to parents, but if they (either of them) strive (to force) you to join with Me (in worship) anything of which you have no knowledge, dont obey them. You have (all) to return to Me, and I will tell you (the Truth) of all that you did. (Ch. 29, Al-Ankabut, verse 8).
As for advising and preaching to parents, you can see the example of how Prophet Ibrahim preached to his father. Allah says: And mention in the Book (the story of) Ibrahim: he was a man of truth; a Prophet. Behold, he said to his father: O my father, why worship that which hears not and sees not and can profit you nothing? O my father, knowledge has come to me which has not reached you, so follow me. I will guide you to a way that is even and straight. O my father, serve not Satan, for Satan is a rebel against (God) the Most Gracious. O my father, I fear lest a Chastisement afflict you from (God) the Most Gracious, so that you become to Satan a friend. The father replied: Are you shrinking from my gods o Ibrahim? If you desist not, I will stone you. Now get away from me for a good long while. Ibrahim said: Peace be on you. I will pray to my Lord for your forgiveness, for He is to me Most Gracious. (Ch. 16 Mary, verses 4147). These verses provide a fine outline of how to treat parents who are not Muslims, how to preach to them and what to do if they resist.
Other verses that talk about dealing with parents: ch. 31, v. 14-15; ch. 46, v. 15)
you can find my articles on facebook / viewsnet
Last edited by Muhaba; 06-15-2012 at 10:47 AM.


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Timmy's Basement Babe – Inque
Celebrating Tattooed ladies week, I wanted some fictional character that definitely fits the theme... so why not a giant tattoo... let's go into the future of Batman...
Celebrating Tattooed ladies week, I wanted some fictional character that definitely fits the theme... so why not a giant tattoo... let's go into the future of Batman...
Much like how fans are pining for Wolverine and Spider-Man to team up with the Avengers in a cinematic blowout, so too are they hoping for a Superman and Batman crossover. A while ago, back when Joseph Gordon-Levitt was rumored to star as the Dark Knight in 'Man of Steel 2' or some standalone film in the universe, talk branched off into a possible big-screen team-up for these two heroes. Now sources say that this will actually happen.
It's that special time of year when each of us takes stock of our relationship to dear old dad and shops for the appropriate necktie to give him on Father's Day. To make this gift extra-personal, it's customary to include a thoughtful note, telling your dad what makes him special.
Those are the chilling final words scrawled in capital letters on the last page of a diary the late Heath Ledger kept as he was filming 'The Dark Knight,' his last finished movie. Ledger's father, Kim, opened up Ledger's Joker diary publicly for the first time for the upcoming documentary 'Too Young to Die,' giving fans a fascinating glimpse into how the late actor created one of the most memorable movie villains of all-time.
The star of such topless films as "Havoc" & "Love & Other Drugs", this lady is an amazing actress in such movies where she does not appear Topless as in a BUTT LOAD OTHERS,
She's hot, sassy, & will kill you just for lookin' at her funny... unless you're making a joke! Yes Batman's arch enemy's girlfriend Harley Quinn is your Basement Babe of the Night!
Even the most diehard of fanboys must be sick of all the 'Dark Knight' teasers and promos flooding their respective Batcaves. Just when you think you've hit your limit, 'Late Night with Jimmy Fallon' reaches into its utility belt and pulls out this ridiculous re-dub of the 'Dark Knight Rises' trailer voiced by everyone's favorite playpal Pee-Wee Herman.
Just when we thought the floodgate of 'Dark Knight Rises' clips and promotional material was closed shut after the latest release of the Mondo poster, here comes two more scenes from the long-awaited finale to the Batman trilogy.
I'll start by saying that I love geeky things, but not for the sake of loving geeky things. Does that makes sense? Just because it has Super Mario or Batman doesn't mean I'll automatically love it as some people try too hard to relate to that geek audience. That, being said, I love this frame-by-frame rendition of the Golden Girls theme replacing the cast with Batman, Superman, Aquaman and Robin.
So we have all heard about those crazy so called "holidays". Like National cream filled doughnut day, National margarita day, and all the other crazy ones. As we all know today is May 1st, but have you ever wondered what crazy and strange holidays land on today?
The trailer for the new Batman movie 'Dark Knight Rises' hits the web. If you haven't seen it yet, what are you waiting for?!


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Northlane New Music Video
at least it wasnt another lyric video.
They get a chance to make one and it's a friggin live music video? DAMMIT.
seems like a fun show, which one's Milo?
Digging: The Mire - Volume: II
The song's pretty cool, but the video's just another boring live video.
Milo's the bassist. Awesome song but the video is pretty boring. These kinds of videos always are.
"They get a chance to make one and it's a friggin live music video? DAMMIT."
Did you miss their Dispossession video or what? This is their 2nd music video from this album.
ah i see, he looks like a fag. lol jks
tbh i like these live videos and it looks like they put up a great show.
Shuyin you've been there from the beginning. You've never ragged on them, but you've never praised them either, so I respect that.
And yeah, I wish they'd come to the US. But I doubt they will anytime soon -_-
Music videos suck 99% of the time, this one's no exception.
Digging: Fluisteraars - Luwte
i praised their debut and tbh i still love that Hollow song, even tho im not much into metalcore right now.
i dig those guitar buildups m/
"Music videos suck 99% of the time, this one's no exception. "
Awesome story.
Not saying the song sucked or anything but this video was boring like most are.
Band and song both rule but a pretty meh video.
Band and song are awesome, Dissposition was a cool video and I was hoping for another cool one.
Omg omg sweet will watch now
Cool venue. What's with Adrians gay haircut? lmfao
might be onto something
Digging: Julia Holter - Have You In My Wilderness
Lol shut up funeral. Band is great
Band and song are awesome, Dissposition was a cool video and I was hoping for another cool one.
Dispossession, bro.
Still dislike the band but I still say the drummer is really decent. I do hope their next album is good since they have plenty of potential to improve.
these guys slay live
These guys are amazing live, plus they are fantastic dudes to hang out with. This band has incredible potential.
^agree their shows are awesome
best song on their full length
don't know if I'll watch this cause metalcore music videos suck almost every time
Just bought my northlane shirt a couple days ago. Sweet vid
not really a music vid Sam, and sweet Alex
Shits expensive though it ships from muthafuckin australia
Northlane vs???
• Brand New release new song as a f..• Tool + Mastodon supergroup• Justin Lowe leaves After the Buri..• Justin Lowe found dead• Cynic break up• Slint guitarist survives suicide ..• Muse unleash new single• Scarlett Johansson forms band• Nickelback get groovy • New Muse song
• Eulogy stream new music• Rock and Roll Hall of Fame 2016• Evergrey keyboardist's single• Mestis releases new music• Jim Konya dies, age 44• Ramleh announce new album• New Anselmo-fronted supergroup• Giant Squid call it a day• Redemption announce new album fea..• Beach House reveal new album• My Chemical Romance release limit..• Massive Attack announce tour; tea..• Vision of Disorder premiere new s..• Satyricon frontman diagnosed with..• Brokencyde unveil new video» see all news
Bands: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


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So, it's December 1, 2013. They get healthcare.gov to work yet? #obamacare
This isn't an academic question, by the way: there are kids with cancer who would like this administration to stop wrecking their health care. Little Hunter Alford needs chemotherapy to treat the rare and deadly cancer he was born with but has lost his health insurance under an administrative blunder seemingly caused by Obamacare. While the president's signature policy promised that no one with a | Read More »


text:
Page 1
Health Care System and Policy Factors
Influencing Engagement in HIV Medical Care:
Piecing Together the Fragments of a Fractured
Health Care Delivery System
Michael J. Mugavero,1Wynne E. Norton,2and Michael S. Saag1
1Department of Medicine, Division of Infectious Diseases, School of Medicine and2Department of Health Behavior, School of Public Health, University
of Alabama at Birmingham, Birmingham, Alabama
Grounded in a socio-ecological framework, we describe salient health care system and policy factors that
influence engagement in human immunodeficiency virus (HIV) clinical care. The discussion emphasizes
successful programs and models of service delivery and highlights the limitations of current, fragmented
health care system components in supporting effective, efficient, and sustained patient engagement across
a continuum of care. A fundamental need exists for improved synergies between funding and service agencies
that provide HIV testing, prevention, treatment, and supportive services. We propose a feedback loop whereby
actionable, patient-level surveillance of HIV testing and engagement in care activities inform educational
outreach and resource allocation to support integrated ''testing and linkage to care plus'' service delivery.
Ongoing surveillance of programmatic performance in achieving defined benchmarks for linkage of patients
who have newly diagnosed HIV infection and retention of those patients in care is imperative to iteratively
inform further educational efforts, resource allocation, and refinement of service delivery.
In recent years, the concept of adherence for patients
infectedwiththe human immunodeficiencyvirus (HIV)
has expanded beyond antiretroviral therapy (ART) to
include adherence to clinical care [1], which is com-
monly referred to as engagement in care. The Health
Resources and Services Administration (HRSA) has
operationalized a continuum of engagement [2, 3],
ranging from those who are not aware of their HIV
status through individuals who are fully engaged in HIV
care (Figure 1). Embedded within this continuum of
care are the processes of engagement: linkage, retention,
and re-engagement in care for those patients who are
lost to follow-up (Figure 2)[4].
In addition to having well-documented health im-
plications for individual patients [5–7], engagement in
HIV care plays a vital role in preventing new HIV in-
fections, which is a critical public health consideration.
A ''test and treat'' (TnT) approach to preventing HIV
infections has garnered considerable interest and en-
thusiasm in a relatively short period of time [8]. Nota-
bly, the success of TnT is contingent upon linkage of
patients with newly diagnosed infection (the ''test''
portion of TnT) to clinical care, such that access to ART
(the ''treat'' portion of TnT) is achieved [9].
The vital role of retention in care beyond initial
linkage to ensure sustained ART cannot be overstated.
Numerous studies have documented high rates of at-
trition within the first year after enrollment in HIV care,
and poor retention has been linked with inconsistent
ART receipt and adherence [4, 5,7,10]. Inan attemptto
moreexplicitlydefine the process,TnThas recentlybeen
The content is solely the responsibility of the authors and does not necessarily
represent the official views of the National Institutes of Health.
Correspondence: Michael J. Mugavero, MD, CCB 142, 908 20thSt South,
Birmingham, AL 35294-2050 (email@example.com).
Clinical Infectious Diseases
? The Author 2011. Published by Oxford University Press on behalf of the
Infectious Diseases Society of America. All rights reserved. For Permissions,
please e-mail: firstname.lastname@example.com.
DOI: 10.1093/cid/ciq048
d CID 2011:52 (Suppl 2)
d Mugavero et al.
Page 2
referred to as ''Testing, Linkage to Care plus'' (TLC1), where
the ''plus'' equals ART [11]. To date, however, there are rela-
tively few evidence-based behavioral- or systems-level inter-
ventions designed to address each of the essential steps of
engagement in care. Moreover, identified efficacious programs
haveyet to bewidelydisseminated,implemented,andintegrated
as standard of care, thereby limiting their potential impact on
public health.
In the current article, our objectives in discussing engagement
in HIV care are 3-fold: (1) to review health care system– and
policy-level factors that influence engagement in HIV care after
HIV testing and diagnosis, (2) to describe successful programs
and health care systems, and (3) to provide initial system- and
policy-level recommendations to improve the current state-of-
the-science and standard of practice. A socio-ecological per-
spective(Figure 3)provides aframeworkfor conceptualizing the
complex interplay of individual-, relationship-, community-,
health care system–, and policy-level factors that influence the
processes of engagement in HIV care [12].
Real-time surveillance of all components of engagement in HIV
care is critical to maximize the use of limited resources, guide
the deployment of evidence-based interventions, and monitor
and respond appropriately to emerging outbreaks, to opti-
mize individual- and population-level HIV health outcomes.
Notably, the ability to track and respond effectively to true HIV
infection incidence in real time is an important goal and, al-
though extraordinarily difficult to implement, remains a top
Unfortunately, current health care systems have limited
patient-level surveillance data regarding engagement in HIV
care and very little capability to measure actual incident cases of
HIV infection [13]. Estimates of the number of patients in HIV
medical care are often based on dated surveillance data or
extrapolated by merging utilization and claims data collected
from public and private sources to provide relatively crude
population estimates [14, 15]. The Centers for Disease Control
and Prevention (CDC) Medical Monitoring Project has
developed a representative sample to allow for surveillance of
clinical outcomes and behaviors among a nationally represen-
tative sample of HIV-infected patients that will be used to
inform prevention and service delivery at a population level
[16]. The shift to patient-level reporting for individuals who
receive HIV supportive and/or treatment services funded by the
Ryan White HIV/AIDS Program may also allow for improved
surveillance for patients supported by this program, who are
estimated to account for roughly one-half of HIV-infected
individuals in the United States. However, more actionable and
innovate systems that capture real-time surveillance data are
Figure 1.
Reprinted from Cheever [2] with permission from the University of Chicago Press.
Health Resources and Services Administration, Human Immunodeficiency Virus (HIV)/AIDS Bureau, continuum of engagement in HIV care.
Figure 2.
optimal clinical outcomes. The processes of engagement in HIV medical care—linkage, retention, and re-engagement—are essential intermediaries for
achieving maximal success of a ''test and treat'' approach to secondary HIV prevention. ART, antiretroviral therapy. Adapted from Ulett et al [4] with
permission from Mary Ann Liebert.
Blueprint for human immunodeficiency virus (HIV) treatment success outlining the requisite steps from HIV testing and diagnosis to achieve
HIV Engagement: System and Policy Factors
d CID 2011:52 (Suppl 2)
d S239
Page 3
required to adequately identify engagement in HIV care
challenge areas and to ultimately guide health care policy.
HIV Testing
Linkage to care is clearly dependant upon HIV testing and
timely receipt of results. However, despite continued em-
phasis on the importance of linkage to medical services for
patients with newly diagnosed infections [17], the activities of
testing and linkage are often uncoupled. Moreover, surveil-
lance of the proportion of patients with newly diagnosed in-
fection entering medical care in a timely fashion is often not
captured by organizations that provide HIV testing services.
Benchmarks of success in this area are not well defined and,
accordingly, are not integrated into HIV testing service
delivery and funding paradigms. Failure to tightly link HIV
testing to HIV care is a key reason for the estimated 300,000
patients who, despite knowing their HIV status, are not in
care and thus pose a greater risk for transmitting HIV to
uninfected individuals [18].
Supportive Services
The importance of supportive services in fostering engagement
by HIV-infected individuals in HIV care has long been recog-
nized. Case management, mental health services, substance
abuse treatment, transportation, and housing assistance have
proven to be invaluable in linking HIV-infected patients to and
retaining them in care [19, 20]. Despite funding through the
Ryan White HIV/AIDS Program, limited availability and ac-
cessibility of these services are frequently encountered by HIV-
infected patients across the United States.
Clinical Care Services
At the clinic level, delays from initial call to initial medical visit
have been associated with HIV-infected patients' failure to
engage in HIV care [21]. Lack of flexibility of clinic hours to
accommodate work schedules and dependant care activities
also serves as a barrier to consistent HIV care [6]. Within the
clinic, culturally appropriate services, coupled with a prevailing
climate of acceptance of all individuals, are essential com-
Similarly, the importance of the patient-provider relationship
has been linked to adherence to ART and to HIV care [6, 22],
highlighting the need for system-level implementation of
educational and training activities for health care providers and
clinic staff members who care for HIV-infected individuals.
HIV Testing and Treatment Guidelines
The revised CDC HIV testing recommendations, which call for
voluntary, routine, opt-out HIV testing of persons aged 13–64
years in all health care settings, have resulted in numerous ini-
tiatives to expand such services in both medical and nonmedical
venues [17, 23]. Notably, however, Walensky et al [24] found
that targeting HIV screening resources toward ensuring that
individuals who have positive test results actually receive their
results and are effectively linked to care was, in fact, more cost
effective than offering testing to additional people. Although
the importance of linkage to care is emphasized in the CDC
guidelines, implementation has often focused on increasing the
emphasis on linking patients to HIV care.
Traditionally, HIV treatment guidelines have focused on
recommendations regarding the use of ART and the manage-
ment of opportunistic infections [25–27], with limited attention
to the importance of engagement in care. In contrast to
prevailing recommendations, the guidelines for primary care
Figure 3.
interplay of individual, relationship, community, health care system, and policy factors that influence the processes of engagement in care. CDC, Centers
for Disease Control and Prevention; CMS, Center for Medicare and Medicaid Services; HIV, human immunodeficiency virus; HRSA, Health Resources and
Services Administration; SAMHSA, Substance Abuse and Mental Health Services Administration.
A social-ecological perspective, which provides the framework for this article's arguments, serves as a road map outlining the complex
d CID 2011:52 (Suppl 2)
d Mugavero et al.
Page 4
of HIV infection issued by the HIV Medicine Association
(HIVMA)in 2009 included
''.emphasis should be placed on the importance of adherence
to care rather than focusingsolely on adherence to medications''
[1]. Language that underscores the clinical importance of the
expanded spectrum of adherence to include engagement in HIV
care should be an essential element of all future HIV treatment
a new recommendation:
Inadequate Funding of HIV Treatment Services
The RyanWhite HIV/AIDSProgram administeredbyHRSAhas
been a life-saving program, serving as a ''payer of last resort'' for
HIV-infected individuals. However,the program is inadequately
funded to effectively address the increasing number of patients
who rely on these services and who face increasingly complex
medical (eg, comorbidities unrelated to AIDS) and supportive
care (eg, housing and substance abuse treatment) needs [28].
For example, despite ?40% increase in the volume of patients,
funding for Ryan White Part C increased by only 2.4% from
2002 through 2008 [29]. Furthermore, within the past year, 13
states witnessed the return of waiting lists for their AIDS Drug
Assistance Programs (ADAP) [30]. The implications of ADAP
waiting lists for HIV testing and care-seeking behaviors at the
individual level are largely unknown, but the inability to access
ART—whether real or perceived—may reduce a patient's mo-
tivation to seek out and/or sustain engagement in HIV care.
Beyond the individual-level, ADAP waiting lists may negatively
influence community-level attitudes and acceptance of HIV
testing and subsequent care-seeking behaviors, particularly
among impoverished and underserved communities, if there is
a prevailing perception that treatment for HIV infection is not
readily available.
Workforce Considerations
In recent years, concerns have been raised regarding the capacity
of the workforce and medical infrastructure serving HIV-
infected patients to absorb the influx of patients with newly
diagnosed infection through expanded HIV testing initiatives
[31]. HIVMA and the Forum for Collaborative HIV Research
recently conducted a survey of clinic capacity and workforce
challenges faced by Ryan White Part C providers, who provide
careto.25% ofHIV-infectedpatientsintheUnitedStates[32].
Workforce shortages were reported by a majority of survey re-
spondents. Moreover, a lack of qualified clinicians specializing
in HIV care, which has resulted from poor reimbursement and
inadequate funding support, was identified as a considerable
challenge in recruiting and retaining providers in primary HIV
care in the future. Regional variation was also observed among
respondents, with more-pronounced workforce limitations in
the South, relative to other regions of the United States,
which translated to longer average waiting times for patient
appointments in this underserved region.
Provider Reimbursement
Current reimbursement for HIV medical service delivery is in-
adequate to support the complex, multidisciplinary care needs
of a growing and aging HIV-infected population. Indeed, HIV
clinical care increasingly focuses on the provision of primary
medical care because of increasing rates of diabetes, hyperten-
sion, and other medical and psychosocial comorbidities (eg,
depression), as well as the medical complexities associated with
aging populations, in the HIV-infected population [28]. Despite
increased demands on health care providers to adequately
respond to the expansive, comprehensive treatment needs of
contemporary HIV care, provider reimbursement accounts for
,2% of overall health care expenditures for HIV-infected
patients, which raises questions about the long-term sustain-
ability of comprehensive HIV medical care [33, 34]. In addition
to serving as a deterrent toward recruiting and retaining
quality health care providers in the workforce, inadequate
reimbursement serves as a disincentive for clinics to provide
expansive services, thereby exacerbating challenges in fostering
engagement in care.
Despite numerous successes in the delivery of services to HIV-
infected patients, service provision remains largely fragmented
[35]. HIV testing and prevention activities are largely under the
purview of the CDC and local and state health departments.
In contrast, HIV treatment and supportive services are funded
predominantly through the HRSA, the Center for Medicare and
MedicaidServices, andprivate insurers, withpublic,private,and
nonprofit organizations delivering services at the local level.
Although varying levels of integration exist within and between
service delivery organizations and funding agencies that provide
testing and/or prevention and medical and/or supportive
services, the vast majority of activities are uncoordinated.
Fragmentation and disparate approaches to these critical
activities and surveillance methods undoubtedly hinder effective
engagement in HIV care efforts and lead to suboptimal use of
limited funds and resources. Individuals with HIV infection
rely on testing, prevention, treatment, and supportive services
across their lifespan, which they should receive across
a continuum, rather than in discrete, fragmented pieces.
The creation of ''medical homes'' for the provision of com-
prehensive, co-located HIV services is an incredible success
largely afforded by the Ryan White HIV/AIDS Program [36].
However, such homes are inadequate to fully address the
complex micro- and macro-level factors pertaining to engage-
ment in HIV care when operating in isolation (Figure 3).
A fundamental need exists for improved synergies among
the public, private, and nonprofit funding and service agencies
HIV Engagement: System and Policy Factors
d CID 2011:52 (Suppl 2)
d S241
Page 5
responsible for the provision of HIV testing, prevention, treat-
ment, and supportive services across the continuum of
engagement [37].
To date, relatively few studies have developed and evaluated pa-
tient- and/or systems-level interventions aimed at improving pa-
tient engagement in HIV care. As a result, limited empirical data
promising patient-level interventions and integrated systems-level
approaches that, together, provide a starting point for the de-
velopment, refinement, and expansion of future efforts to build
evidence-based strategies to improve engagement in HIV care.
Case Management
One ofthe most compelling behavioralinterventionstoimprove
HIV-infected patient linkage to care is the CDC's Antiretroviral
Treatment Access Study (ARTAS). This randomized, controlled
trial evaluated a 90-day strengths-based case management in-
tervention in which individuals with newly diagnosed HIV in-
fection received up to 5 case manager contacts to facilitate
linkage to medical care [38]. Indeed, a greater proportion of
patients who received the case management–based intervention
were enrolled in care within 6 months, compared with patients
in the control group (78% vs 60%; P , .001). The absolute
effect size of nearly 20% reflects the fact that, for every 5 patients
with newly diagnosed infection who received the brief case
management intervention, 1 additional person was linked to
HIV care, representing a highly favorable number needed to
treat. Importantly, similar results were found in an effectiveness
trial conducted with 10 community-based organizations and
health departments (79% of patients were linked to care after
6 months) [39], providing compelling evidence to support
widespread disseminationand
management intervention in real-world settings.
implementationof case
Navigation Models
In recent years, health system navigation has emerged as
a promising approach to improving engagement in HIV
care [40]. Patient navigators are often HIV-infected peers or
near-peers who share similar cultural and socioeconomic
backgrounds as the patient, often playing a distinct and com-
plementary role to case managers and other supportive service
providers. Navigators may assist patients in their awareness and
utilization of medical and supportive service resources available
in a complex, fragmented health care system, and they often also
work with patients to develop behavioral skills to improve
self-care andenhancepatient-providercommunication.Patient-
level health systems navigation has demonstrated promising
results in a series of HRSA Special Projects of National Signifi-
cance activities [40].
Client-Oriented New Patient Navigation to Encourage Con-
nectionto Treatment (Project CONNECT), a system-level,new-
patient navigation program, was launched at the University of
Alabama at Birmingham 1917 HIV Clinic in January 2007 in
response to a 31% new patient ''no show'' rate [21]. CONNECT
employs a patient-focused orientation visit, during which
a trained staff member interacts with patients who are estab-
lishing care to help identify and troubleshoot anticipated bar-
riers to sustained engagement in HIV care. Orientation visits are
conducted within 5 days after the initial patient call, in contrast
to the historical average 28-day wait until an initial provider
visit. Project CONNECT has proven to be successful; the pro-
portion of patients who failed to enroll in HIV care decreased
from 31% to 18% after implementation (odds ratio, 0.54; 95%
confidence interval, 0.38–0.76) [41, 42].
Integrated Health Care Systems
Integrated health care systems, such as Kaiser Permanente and
the US Department of Veterans Affairs (VA), provide insight
into systems-level approaches aimed at improving patient en-
gagement in HIV care. Although such approaches may not be
readily transferable to the general health care system, which is
more fragmented, they nonetheless provide important examples
and lessons learned for future systems-level approaches.
For example, Kaiser Permanente has adopted quality metrics
for linkage and retention in HIV care and employs a shared
electronic medical record for patient surveillance and to provide
feedback to regional networks regarding performance (M.
Horberg, personal communication). Eighty-nine percent of
patients with newly diagnosed HIV infection in the Kaiser
Permanente system are linked to HIV medical care within 90
days, whereas 77% and 86% meet quality measures for retention
in care based on medical visits and completion of HIV-specific
laboratory tests, respectively [43]. Elements of case management
and systems navigation are employed to foster linkage to HIV
medical care, and best practices are shared across the Kaiser
Permanente network.
The VA provides a wide array of integrated medical and
supportive services to a diverse population of eligible benefi-
ciaries across a range of socioeconomic and cultural back-
grounds. A multi-component systems intervention capitalizing
on a shared electronic medical record across VA centers and
incorporating provider education, feedback, electronic re-
minders, and social marketing has proven to be successful in
increasing HIV testing and case identification rates [44]. Cur-
rently, practices for linkage to care include identification of an
HIV care coordinator at each VA medical center who is alerted
to a positive HIV test result and charged with facilitating
d CID 2011:52 (Suppl 2)
d Mugavero et al.